Zero-truncated Negative Binomial Regression Model Research Articles

The role of perceived quality of care on outpatient visits to health centers in two rural districts of northeast Ethiopia: a community-based, cross-sectional study

BackgroundPatients who have had a negative experience with the health care delivery bypass primary healthcare facilities and instead seek care in hospitals. There is a dearth of evidence on the role of users’ perceptions of the quality of care on outpatient visits to primary care facilities. This study aimed to examine the relationship between perceived quality of care and the number of outpatient visits to nearby health centers.MethodsA community-based cross-sectional study was conducted in two rural districts of northeast Ethiopia among 1081 randomly selected rural households that had visited the outpatient units of a nearby health center at least once in the previous 12 months. Data were collected using an interviewer-administered questionnaire via an electronic data collection platform. A multivariable analysis was performed using zero-truncated negative binomial regression model to determine the association between variables. The degree of association was assessed using the incidence rate ratio, and statistical significance was determined at a 95% confidence interval.ResultsA typical household makes roughly four outpatient visits to a nearby health center, with an annual per capita visit of 0.99. The mean perceived quality of care was 6.28 on a scale of 0–10 (SD = 1.05). The multivariable analysis revealed that perceived quality of care is strongly associated with the number of outpatient visits (IRR = 1.257; 95% CI: 1.094 to 1.374). In particular, a significant association was found for the dimensions of provider communication (IRR = 1.052; 95% CI: 1.012, 1.095), information provision (IRR = 1.088; 95% CI: 1.058, 1.120), and access to care (IRR = 1.058, 95% CI: 1.026, 1.091).ConclusionsService users’ perceptions of the quality of care promote outpatient visits to primary healthcare facilities. Effective provider communication, information provision, and access to care quality dimensions are especially important in this regard. Concerted efforts are required to improve the quality of care that relies on service users’ perceptions, with a special emphasis on improving health care providers’ communication skills and removing facility-level access barriers.

Temporal trends of stroke incidence over 14 years in Iran: Findings of a large-scale multi-centric hospital-based registry

Background: The burden of stroke is high worldwide, especially in low-middle income countries. We aim to explore the temporal trends of the incidence rate (IR) of stroke over 14 years in Iran’s central areas. Methods: Stroke registry as part of cardiovascular disease (CVD) registry in Isfahan that focused on hospitalized patients (≥15 years) with first or recurrent stroke from 2001 to 2015. Factors included date of symptoms, demographics, management, survival at 28 days, date of admission, history of stroke, and other CVD and clinical diagnosis according to Computer Tomography Scan. We calculated age-, sex, and place-of-residence-adjusted IR based on multiple reference populations. Data were analyzed by bootstrap robust zero-truncated negative binomial regression models using R Statistical Software. Results: From 19,174 registered patients with stroke assessed by ICD-10; 18,010 (93.93%) cases were identified based on WHO-MONICA. Approximately 51% of hospitalized stroke patients were women. The average annual increase in stroke incidence based on ICD-10 ranged from 1.56% (95% CI, 0.14, 2.97) to 2.67% (95% CI, 1.25, 4.09) for different reference populations. In addition, a similar trend was also observed for stroke IR based on WHO-MONICA during the study period for the whole reference population, with an average annual change of 2.5% (95% CI, 1.28, 3.72) to 3.64 % (95% CI, 2.47, 4.82). Conclusion: Given that temporal trends of stroke have increased in both sexes, especially in Iran’s urban areas, prevention programs are needed for public awareness and physician motivation in order to identify risk factors as well as primary and secondary prevention.

Responding to harvest failure: Understanding farmers coping strategies in the semi-arid Northern Ghana.

Farmers coping strategies against harvest failures have implication for future adaptation to such shocks. Previous studies on farmers' vulnerability and response to shocks have emphasized on adaptation, at the expense of their coping to such shocks. Using a survey data from 299 farm households in northern Ghana, this study has analyzed farmers' coping strategies against harvest failure, and the drivers of the choice and intensity of the coping strategies. The empirical results show that most of the households used liquidation of productive assets, reduction in consumption, borrowing from family and friends, diversification of livelihoods, and migration to cities for off-farm jobs as coping measures in response to harvest failure. The empirical results from a multivariate probit model indicate that the choice of coping strategies is influenced by farmers' access to radio, net value of livestock produced per man-equivalent (ME), experience of yield loss in the previous year, farmers' perception about the fertility status of their crop fields, access to credit, distance to market, farm-to-farmer extension, location of the respondent, cropland per ME, and access to off-farm income. Empirical results from a zero-truncated negative binomial regression model also indicate that the number of coping strategies adopted increases with the value of farm implements, access to radio, farmer-to-farmer extension and being located in the regional capital. It however decreases with the age of the household head, number of family members abroad, a positive perception about the fertility status of crop fields, access to government extension services, distance to market, and access to off-farm income. Limited access to credit, radio, and markets renders farmers more vulnerable and pushes them to adopt more costly coping strategies. In addition, an increase in income earned from secondary livestock products decreases incentive for farmers to adopt liquidation of productive assets as coping strategy after a harvest failure. Policy makers and stakeholders could make smallholder farmers less vulnerable to harvest failure by enhancing their access to radio, credit, off-farm income and market, promotion of farmer-to-farmer extension, implementing measure to improve the fertility of crop fields in the study area, and enhancing farmers' engagement in the production and selling of secondary livestock products.

Nursing Resources Linked to Postsurgical Outcomes for Patients With Opioid Use Disorder: An Observational Study.

Objectives:To determine whether better nursing resources (ie, nurse education, staffing, work environment) are each associated with improved postsurgical outcomes for patients with opioid use disorder (OUD).Background:Hospitalized patients with OUD are at increased risk of adverse outcomes. Evidence suggests that adverse postsurgical outcomes may be mitigated in hospitals with better nursing resources, but this has not been evaluated among surgical patients with OUD.Methods:Cross-sectional (2015–2016) data were utilized from the RN4CAST-US survey of hospital nurses, the American Hospital Association Annual Survey of hospitals, and state patient hospital discharge summaries. Multivariate logistic and zero-truncated negative binomial regression models were employed to examine the association between nursing resources and 30-day readmission, 30-day in-hospital mortality, and length of stay for surgical patients with OUD.Results:Of 919,601 surgical patients in 448 hospitals, 11,610 had identifiable OUD. Patients with compared to without OUD were younger and more often insured by Medicaid. Better nurse education, staffing, and work environment were each associated with better outcomes for all surgical patients. For patients with OUD, each 10% increase in the proportion of nurses with a bachelor’s degree in nursing was associated with even lower odds of 30-day readmission (odds ratio [OR] = 0.88; P = 0.001), and each additional patient-per-nurse was associated with even lower odds of 30-day readmission (OR = 1.09; P = 0.024).Conclusions:All surgical patients fare better when cared for in hospitals with better nursing resources. The benefits of having more nurses with a bachelor’s degree and fewer patients-per-nurse in hospitals appear greater for surgical patients with OUD.

Household-level risk factors for Aedes aegypti pupal density in Guayaquil, Ecuador

BackgroundVector-borne diseases are a major cause of disease burden in Guayaquil, Ecuador, especially arboviruses spread by Aedes aegypti mosquitoes. Understanding which household characteristics and risk factors lead to higher Ae. aegypti densities and consequent disease risk can help inform and optimize vector control programs.MethodsCross-sectional entomological surveys were conducted in Guayaquil between 2013 and 2016, covering household demographics, municipal services, potential breeding containers, presence of Ae. aegypti larvae and pupae, and history of using mosquito control methods. A zero-truncated negative binomial regression model was fitted to data for estimating the household pupal index. An additional model assessed the factors of the most productive breeding sites across all of the households.ResultsOf surveyed households, 610 satisfied inclusion criteria. The final household-level model found that collection of large solid items (e.g., furniture and tires) and rainfall the week of and 2 weeks before collection were negatively correlated with average pupae per container, while bed canopy use, unemployment, container water volume, and the interaction between large solid collection and rainfall 2 weeks before the sampling event were positively correlated. Selection of these variables across other top candidate models with ∆AICc < 1 was robust, with the strongest effects from large solid collection and bed canopy use. The final container-level model explaining the characteristics of breeding sites found that contaminated water is positively correlated with Ae. aegypti pupae counts while breeding sites composed of car parts, furniture, sewerage parts, vases, were all negatively correlated.ConclusionsHaving access to municipal services like bulky item pickup was effective at reducing mosquito proliferation in households. Association of bed canopy use with higher mosquito densities is unexpected, and may be a consequence of large local mosquito populations or due to limited use or effectiveness of other vector control methods. The impact of rainfall on mosquito density is multifaceted, as it may both create new habitat and “wash out” existing habitat. Providing services and social/technical interventions focused on monitoring and eliminating productive breeding sites is important for reducing aquatic-stage mosquito densities in households at risk for Ae. aegypti-transmitted diseases.Graphical

Hospital nurse staffing and patient outcomes in Chile: a multilevel cross-sectional study

Unrest in Chile over inequalities has underscored the need to improve public hospitals. Nursing has been overlooked as a solution to quality and access concerns, and nurse staffing is poor by international standards. Using Chile's new diagnosis-related groups system and surveys of nurses and patients, we provide information to policy makers on feasibility, net costs, and estimated improved outcomes associated with increasing nursing resources in public hospitals. For this multilevel cross-sectional study, we used data from surveys of hospital nurses to measure staffing and work environments in public and private Chilean adult high-complexity hospitals, which were linked with patient satisfaction survey and discharge data from the national diagnosis-related groups database for inpatients. All adult patients on medical and surgical units whose conditions permitted and who had been hospitalised for more than 48 h were invited to participate in the patient experience survey until 50 responses were obtained in each hospital. We estimated associations between nurse staffing and work environment quality with inpatient 30-day mortality, 30-day readmission, length of stay (LOS), patient experience, and care quality using multilevel random-effects logistic regression models and zero-truncated negative binomial regression models, with clustering of patients within hospitals. We collected and analysed surveys of 1652 hospital nurses from 40 hospitals (34 public and six private), satisfaction surveys of 2013 patients, and discharge data for 761 948 inpatients. Nurse staffing was significantly related to all outcomes, including mortality, after adjusting for patient characteristics, and the work environment was related to patient experience and nurses' quality assessments. Each patient added to nurses' workloads increased mortality (odds ratio 1·04, 95% CI 1·01-1·07, p<0·01), readmissions (1·02, 1·01-1·03, p<0·01), and LOS (incident rate ratio 1·04, 95% CI 1·01-1·06, p<0·05). Nurse workloads across hospitals varied from six to 24 patients per nurse. Patients in hospitals with 18 patients per nurse, compared with those in hospitals with eight patients per nurse, had 41% higher odds of dying, 20% higher odds of being readmitted, 41% higher odds of staying longer, and 68% lower odds of rating their hospital highly. We estimated that savings from reduced readmissions and shorter stays would exceed the costs of adding nurses by US$1·2 million and $5·4 million if the additional nurses resulted in average workloads of 12 or ten patients per nurse, respectively. Improved hospital nurse staffing in Chile was associated with lower inpatient mortality, higher patient satisfaction, fewer readmissions, and shorter hospital stays, suggesting that greater investments in nurses could return higher quality of care and greater value. Sigma Theta Tau International, University of Pennsylvania Global Engagement Fund, University of Pennsylvania School of Nursing's Center for Health Outcomes, and Policy Research and Population Research Center. For the Spanish translation of the abstract see Supplementary Materials section.

Application of zero-truncated count data regression models to air-pollution disease

Count data consist of non-negative integers that have many applications in various fields of studies. To handle count data, there are various statistical models that can be employed corresponding to the properties of the count data studied. Poisson regression model (PRM) is mostly used to model data with equidispersion, while negative binomial regression model (NBRM) is a model that is regularly employed to model over-dispersed count data. On the other hand, the usual count data regression models may not able to handle strictly positive counts. In this case, the appropriate model for the analysis of such data would be models truncated at zero. We are interested to study the relationship between pollution related disease with influential factors such as air pollution and climate variables in Johor Bahru, Malaysia, using these zero-truncated models, where the number of disease cases are strictly positive. In particular, the zero-truncated PRM and NBRM are used to determine the association between the number of dengue patients and their influential factors. From the study, zero-truncated NBRM is found to be the best model amongst the two models to model the relationship between the number dengue cases and air pollution and climate. Air pollution factors that significantly affect the number of cases for dengue are particulate matter (PM10) and sulfur dioxide. Also, humidity and temperature are the climate factors that significantly affect the number of dengue cases.

Effect of Built Environment Factors on Pedestrian Safety in Portuguese Urban Areas

This paper identifies and analyzes variables that influence pedestrian safety based on the definition of models of pedestrian crash frequency for urban areas in Portugal. It considers three groups of explanatory variables, namely: (i) built environment; (ii) pedestrian infrastructure, and (iii) road infrastructure, as well as exposure variables combining pedestrian and vehicular traffic volumes. Data on the 16 variables considered were gathered from locations in the counties of Braga and Guimarães. The inclusion of pedestrian infrastructure variables in studies of this type is an innovation that allows for measuring the impacts of the dimensions recommended for this type of infrastructure and assessing the implementation of policies to support the mobility of vulnerable users, especially pedestrians. Examples of such variables are unobstructed space for pedestrian mobility and the recommendable distance separating regulated crossings. Zero-Truncated Negative Binomial Regression Models (ZTNB) and Generalized Estimation Equations (GEE) are used to develop crash prediction models. Results show that in addition to the variables identified in similar studies such as carriageway width, other statistically significant variables like longitudinal slope and distance between crosswalks have a negative influence on pedestrian safety. On-street parking places, one-way streets, and the existence of raised medians have an opposite contribution to safety.

Power of Overdispersion Tests in Zero-Truncated Negative Binomial Regression Model

Poisson regression is the most extensively used model for modeling data that are measured as counts. The main characteristic of Poisson regression model is the equidispersion limitation in which the mean and variance of the count variable are the same. However, in many situations the variance of the count variable is greater than the mean which causes overdispersion, and hence, poor fit will be resulted when inference about regression parameters. Alternatively, the negative binomial regression is preferred when overdispersion is present. In addition, in particular cases, the zero counts are not observed in data which is known as zero-truncation. In the presence of overdispersion in zero-truncated count data, the zero-truncated negative binomial (ZTNB) regression model can be used as an alternative to zero-truncated Poisson (ZTP) regression model. In this paper, for testing overdispersion in ZTNB regression model against ZTP regression model, the likelihood ratio test (LRT), score test, and Wald test are proposed. A Monte-Carlo simulation is carried out in order to examine the empirical power for statistics of these tests under different levels of overdispersion and various sample sizes. The simulation results indicate that Wald test is more powerful than the LRT and score test for detecting the overdispersion parameter in ZTNB regression model against ZTP regression model, since it provides the highest statistical power. Thus, the Wald test is preferable for detecting the overdispersion problem in zero-truncated count data.

Temporal Trends of the Incidence of Ischemic Heart Disease in Iran Over 15 Years: A Comprehensive Report from a Multi-Centric Hospital-Based Registry.

BackgroundWe sought to explore the temporal trend of ischemic heart disease (IHD) incidence rate (IR) in a large city of Iran.MethodsThe study population comprised hospitalized patients who were living in Isfahan, Iran, with first or recurrent IHD during the period of 2001 to 2016. To identify patients, clinical diagnostic codes were applied according to the International Classification of Diseases 10 (ICD-10: I20.0, I21–I25) and the “World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease” diagnostic categories (WHO-MONICA). Using a direct method, we calculated age-, sex-, and place-of-residence-adjusted incidence rates based on multiple reference populations. To examine the long-term trend for the IR, a bootstrap robust zero-truncated negative binomial regression model was used.ResultsA total of 102,254 hospitalized patients, with a mean (SD) age of 61.85 (12.79), were registered between 2001 and 2016. After an initial reduction from 2006 to 2010, crude and adjusted IRs of IHD increased between 2010 and 2016. We further observed a significant increasing long-term temporal trend in the IR with an average annual change of 1.42% to 3.36% over the study period.ConclusionOur findings showed a decreasing trend in the IR of IHD between 2006 and 2010, possibly attributed to the comprehensive community-based interventions named “Isfahan Healthy Heart Program” performed from 2001 to 2007, followed by an increase in the adjusted IR of IHD between 2010 and 2016 in Isfahan; this indicates the importance of continuing the preventive measures to preclude the risk factors of cardiovascular diseases in our population.

The climate index-length of stay nexus

This study sought to analyze the effect of the climate of tourists’ region of origin on their length of stay in a specific inland destination as climate of origin has been ignored in previous analyses. The present study collected data from 674 valid surveys of visitors in the selected destination and applied a zero-truncated negative binomial regression model and a Poisson-inverse Gaussian regression model. The results for this destination suggest that climate of origin affects tourists’ length of stay. This finding was obtained via the Poisson-inverse Gaussian regression model because of its greater tolerance to long tail distributions. Similarities and differences were found regarding results for other destinations found in the literature. The present findings further include the non-significant effect of reasons for traveling and tourists’ satisfaction and the significant influence of tourists’ mode of transport, income, and age on length of stay. Cheaper lodging categories also have an important impact on visitors who prefer extended stays.

Porto street stage at Rally Portugal: the determinants of the length of stay

ABSTRACTWe present the determinants of the length of stay (LOS) of Porto Street Stage that integrated the program of the 52nd edition of Rally de Portugal. Sport events assume an important role in the marketing of tourism destinations. However, when we compare them with other segments in tourism, it still remains underexplored. This study represents an opportunity to contribute to the literature, and it could become a significant toll for the organizers, public entities and other stakeholders. We contemplate a set of information and data that may improve the management of the future editions in a more rigorous and effective way. As we are dealing with an international event, it is an occasion to enlist tourists and promote the tourist destination. We applied a quantitative analysis and considered the sociodemographic characteristics of the spectators, factors that influenced the trip, expenses per day in the city, level of satisfaction with the event, and the intention to return. An OLS regression model, a Weibull survival model and a zero-truncated negative binomial regression model were estimated, and the results were compared. On the LOS determinants it is not common to consider the influence of each item of expenditure during the stay and the satisfaction levels with the event and different effects were observed. The travel and accommodation expenditures present a negative effect on the LOS. In the opposite side the satisfaction level and intention to return, both present a positive effect on the LOS. The sociodemographic characteristics have diverse impacts on the LOS.

Assessing the Recreational Value of a National Forest Park from Ecotourists’ Perspective in Taiwan

The Huisun National Forest Recreation Area (HNFRA), which preserves over 85% of the forest to its natural state, provides many forest services, including environmental exploration, ecological conservation, recreation, and ecotourism in Taiwan. This study used analytical methods to analyze the recreational demands that influence tourists’ visits and the recreational value of tourism. The travel cost method (TCM) and the zero-truncated negative binomial regression model to assess the recreational value were chosen. The results revealed that the travel costs for nonlocal visitors were higher than those for local visitors by NT$818.59. The recreational demand was negatively correlated to income and had a significantly positive correlation with place of residence, age, and length of stay. The estimated annual recreational value of HNFRA was NT$3237 per person, and the total annual recreational value was NT$347,270,560. Raising the idea that recreational demand and the willingness to consume has a direct impact on the recreational value. Enhancing the site’s recreational value will be beneficial to ecotourists’ experiences and the management of HNFRA.

National Trends in and Correlates of Nonmedical Use of Prescription Stimulants, Nonmedical Use Frequency, and Use Disorders.

To examine national trends in and correlates of nonmedical use of prescription stimulants, nonmedical use frequency, and use disorders among individuals aged 12-64 years. Data from 783,400 persons aged 12-64 who participated in the 2003-2014 National Surveys on Drug Use and Health (NSDUH). Descriptive analyses and bivariable and multivariable logistic regression and zero-truncated negative binomial regression models were applied. Our multivariable results show that among individuals aged 12-64, the national prevalence of nonmedical use of prescription stimulants in 2003-2004 was higher than in 2007-2008 and was similar to that in 2009-2011, but was lower than in 2013-2014. Among those who used prescription stimulants nonmedically, the frequency of nonmedical use of prescription stimulants in 2003-2004 was lower than that in 2005-2006 and was similar to that in 2007-2014, and the prevalence of prescription stimulant use disorders in 2003-2004 was higher than that in 2005-2010, but was similar to that in 2011-2014. Among nonmedical prescription stimulant users aged 12-64 in 2013-2014, 53.2% reported that their source of stimulants used nonmedically last time was from relatives/friends for free. Our study also identified correlates of prescription stimulant nonmedical use, use frequency, and use disorders. Co-occurring substance use disorders are common among those with prescription stimulant nonmedical use problems. Among individuals aged 12-64 in the United States, after adjusting for covariates, the prevalence of nonmedical use of prescription stimulants in 2013-2014 was higher than that in 2003-2004. The results of this study help inform and target efforts to reduce prescription stimulant nonmedical use, use frequency, and use disorders.

Environmental, Spatial, and Sociodemographic Factors Associated with Nonfatal Injuries in Indonesia.

Background. The determinants of injuries and their reoccurrence in Indonesia are not well understood, despite their importance in the prevention of injuries. Therefore, this study seeks to investigate the environmental, spatial, and sociodemographic factors associated with the reoccurrence of injuries among Indonesian people. Methods. Data from the 2013 round of the Indonesia Baseline Health Research (IBHR 2013) were analysed using a two-part hurdle regression model. A logit regression model was chosen for the zero-hurdle part, while a zero-truncated negative binomial regression model was selected for the counts part. Odds ratio (OR) and incidence rate ratio (IRR) were the measures of association, respectively. Results. The results suggest that living in a household with distant drinking water source, residing in slum areas, residing in Eastern Indonesia, having low educational attainment, being men, and being poorer are positively related to the likelihood of experiencing injury. Moreover, being a farmer or fishermen, having low educational attainment, and being men are positively associated with the frequency of injuries. Conclusion. This study would be useful to prioritise injury prevention programs in Indonesia based on the environmental, spatial, and sociodemographic characteristics.

Students' summer tourism: Determinants of length of stay (LOS)

Studies scrutinizing the economic aspects of student tourism at the micro-level are rare in the literature. Set against this background, the present study examines the variation in a sample of Norwegian students' length of stay at summer vacation destinations in 2014. Three estimation methods – an OLS regression model, a Weibull survival model and a zero-truncated negative binomial regression model – provide qualitatively similar results regarding how a number of determinants affect length of stay. In particular, the results show that daily trip costs, booking time, tourism and trip motives, trip month and gender explain much of the variation in length of stay. Of special interest is the comparison of two segments differing on when trip duration is determined: the “pre-fixed” returners (75% of the sample) and the “open” returners (25%). In this regard, the results suggest that the “open” returners stay longer on their trips than the “pre-fixed” ones. Finally, the study provides some implications for future length of stay research.

Is secondhand smoke exposure associated with increased exacerbation severity among children hospitalized for asthma?

To determine the association between secondhand smoke (SHS) exposure and length of stay (LOS) and other exacerbation severity indicators in children hospitalized for asthma. We conducted a retrospective chart review at 2 children's hospitals. Patients aged 2 to 18 hospitalized for asthma in 2012 were included. Outcome variables included LOS, PICU, magnesium, and intravenous (IV) steroids. Bivariate analysis determined differences between SHS-exposed and non-SHS-exposed groups. Geometric means were used for LOS to account for skewed distribution. Logistic and zero-truncated negative binomial regression models were used to determine the independent association between SHS exposure and hospitalization severity indicators. A total of 623 patients were included; 41% reported SHS exposure. Mean LOS was 47.5 hours. In the SHS-exposed group, LOS was 50.0 (95% confidence interval [CI] 46.7-54.0) and in the nonexposed group it was 45.8 (95% CI 43.4-48.4) (P = .02). In regression analysis, institution modified the effect of SHS exposure on LOS. At Children's Hospital Colorado, SHS exposure was associated with a 20% increase in LOS (incidence rate ratio 1.2, 95% CI 1.1-1.3). At the Medical University of South Carolina, there was no significant association. SHS-exposed patients were more likely to receive IV steroids (odds ratio 1.6, 95% CI 1.1-2.3) CONCLUSIONS: Among children hospitalized for asthma, we identified a significant association at 1 institution between SHS exposure and LOS and found that IV steroid use was significantly associated with LOS at both institutions. Eliminating SHS exposure among children with asthma is important.

Socio-economic Patterns in Inpatient Care Utilisation in India: Is the Income Effect Withering?

Though a few studies are available with regard to socio-economic differentials in health care utilisation in India, no attempt has been made to understand the underlying decision-making process in health care utilisation. Therefore, in this article, an attempt is made to examine the utilisation of inpatient care in India, focusing on the socio-economic determinants of the extent of inpatient care use. The health care utilisation model adopted by Manning et al., (1987, American Economic Review, 77(3), 251–77), and Pohlmeier and Ulrich (1995, The Journal of Human Resources, 30(2), 339–61) was employed for studying the above objective. Cross-sectional data are taken from National Sample Survey Organization’s 60th round (2004) survey on ‘morbidity and health care’. While a two-part (double-hurdle) model is estimated for the frequency of hospitalisations, a zero-truncated negative binomial regression model is applied for the length of stay (LOS) in a hospital. The results suggest that controlling other factors, people from richer households were more likely to seek hospital admission and use inpatient care more frequently than their poorer counterparts, consistent with the supposition that rich people have greater access to health care. However, the analyses suggest that with respect to income, equity has been achieved for the LOS in the hospital for individuals suffering from various diseases. This means that income inequity exists at the time of hospital admission but once they are admitted, the duration of stay at hospital is no longer determined by their economic status. However, this requires careful interpretation because it is quite likely that poor people may have been forced to sell off assets or borrow money for meeting the cost of hospitalisation for longer duration of stay. The above argument is strengthened by the fact that when socio-economic status is measured by education, inequity continues to persist, with illiterates having longer LOSs in the hospital. The policy measure that the government could take to improve the access of quality health care services for the poor is to strengthening the public health system through enhanced investments in the National Health Mission. JEL Classification: I140

People with multiple unhealthy lifestyles are less likely to consult primary healthcare.

BackgroundBehavioural interventions are often implemented within primary healthcare settings to prevent type 2 diabetes and other lifestyle-related diseases. Although smoking, alcohol consumption, physical inactivity and poor diet are associated with poorer health that may lead a person to consult a general practitioner (GP), previous work has shown that unhealthy lifestyles cluster among low socioeconomic groups who are less likely to seek primary healthcare. Therefore, it is uncertain whether behavioural interventions in primary healthcare are reaching those in most need. This study investigated patterns of GP consultations in relation to the clustering of unhealthy lifestyles among a large sample of adults aged 45 years and older in New South Wales, Australia.MethodsA total of 267,153 adults participated in the 45 and Up Study between 2006 and 2009, comprising 10% of the equivalent demographic in the state of New South Wales, Australia (response rate: 18%). All consultations with GPs within 6 months prior and post survey completion were identified (with many respondents attending multiple GPs) via linkage to Medicare Australia data. An index of unhealthy lifestyles was constructed from self-report data on adherence to published guidelines on smoking, alcohol consumption, diet and physical activity. Logistic and zero-truncated negative binomial regression models were used to analyse: (i) whether or not a person had at least one GP consultation within the study period; (ii) the count of GP consultations attended by each participant who visited a GP at least once. Analyses were adjusted for measures of health status, socioeconomic circumstances and other confounders.ResultsAfter adjustment, participants scoring 7 unhealthy lifestyles were 24% more likely than persons scoring 0 unhealthy lifestyles not to have attended any GP consultation in the 12-month time period. Among those who attended at least one consultation, those with 7 unhealthy lifestyles reported 7% fewer consultations than persons with 0 unhealthy lifestyles. No effect modification was observed.ConclusionTo optimise the prevention of lifestyle-related diseases, interventions for positive behavioural change need to incorporate non-primary healthcare settings in order to reach people with multiple unhealthy lifestyles.

The effect of comorbidity on hospital mortality in patients with SLE from an Asian tertiary hospital

The objective of the study was to assess the disease burden of systemic lupus erythematosus (SLE) and the usefulness of the Charlson Comorbidity Index (CCI) as risk-adjusted hospital mortality predictors in patients with SLE using a hospital administrative database. A historical cohort study of a hospital discharge database from 2004 to 2011 was used to identify cases with SLE and comorbidity using the International Statistical Classification of Diseases and Related Health Problems, ninth revision, Australian modification (ICD-9-AM) codes. Over the eight years, 841 patients met the criteria of SLE with a hospital mortality rate of 9.2%. The hospital mortality rates (2.4%, 15.7%, 25.0%, and 30.4%, respectively, p < 0.001) and hospital length of stay (geometric mean, 3.5, 5.6, 8.8, and 7.5 days, respectively, p < 0.001) were consistently increased for patients with CCI ranging from none, low, moderate to high grade, respectively. Cox proportional hazards model analysis showed that CCI (hazard ratio (HR) 7.8 high vs. none, p < 0.001) and infectious disease (HR 2.0, p = 0.016) were significant and independent predictors of hospital mortality. Similar results were also seen with hospital length of stay by zero-truncated negative binomial regression model analysis. The SLE burden is high in this population. Comorbidities and infectious disease were some of the most important contributors to hospital mortality and resource utilization.